Consultants key to risk in intensive care units

Patients have nearly twicethe chance of dying in some hospital intensive care units compared with others, even if they arrive at the hospital with the same severity of illness or organ failure, according to a report published today.

Patients have nearly twicethe chance of dying in some hospital intensive care units compared with others, even if they arrive at the hospital with the same severity of illness or organ failure, according to a report published today.

The Audit Commission found that huge variations in hospital death rates could be caused by the way consultants cover intensive care units. Units employing consultants to work one day a week have higher death rates than those that employ consultant working one week on and then two or three weeks off, the commission found, and one-third have rates far above the average.

The study of 50 intensive care units shows for the first time true variations in care, as the type of patient, his or her age, sex and medical history, as well as the severity of the illness have been taken into account.

"It is a cause for concern and needs investigating," said Dr Colin Ferguson, a consultant in anaesthesia and intensive care medicine at Homerton Hospitals NHS Trust in east London. "The shift patterns are probably a surrogate marker for how interested consultants are in intensive care treatment. Those that do one week on and then two or three weeks off, probably are doing research, or going to conferences on intensive care and are more interested.

"The report shows that it is not just about having more beds, but about efficiency," Dr Ferguson said. "Often we have the wrong person taking up an intensive care bed because they need help with breathing that cannot be done anywhere else in the hospital."

The findings showed that 37 of the 50 units employed consultants for one day a week. Only nine used the week on/two weeks off pattern, and the rest used a mixture of the two.

The review of intensive care units,
Critical to Success, is the most comprehensive survey yet of services in England and Wales. It found that the units save on average two in every three patients' lives and cost Britain about £700m a year in total.

"Despite the rising costs, which have seen an addition 5 to 10 per cent invested each year, and 50 per cent more beds in the last six years, there is still an issue with the quality of care and survivors quality of life afterwards," said Dick Waite, the author of the research. "The report shows that more beds is not the whole answer. It is about how hospital use the beds."

Between one-quarter and one-third of hospitals incur extra costs and place unnecessary strain on critical care beds by keeping patients in such units after giving epidurals to relieve pain from major surgery, the researchers found.

There was no relationship between staffing levels or doctors' and nurses' qualifications and death rates. Neither did the type of hospital make a difference to patient mortality.

The reportcriticised the way that many patients on general wards end up in intensive care. "Doctors and nurses on the general ward need to be trained in looking for the danger signs of critical illness," said Dr Ferguson. The figures show that 80 per cent of people who have a heart attack on a general ward die in intensive care, compared with 70 per cent of those who are referred by accident and emergency units.

The report concluded that critical care units can become the backstop of a poorly performing hospital, but they can also reduce the hospital's efficiency if surgery has to be cancelled because unit beds are mismanaged.